Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumatologic Diagnoses This project responds to a critical shortage of pediatric rheumatologists by enlisting top rheumatologists to encapsulate the diagnostic information in their field in the most advanced decision support software tool for diagnosis. The SimulConsult tool is in active clinical use worldwide by specialists in neurology and genetics. This project focuses on two key feasibility questions with which to assess SimulConsult's market potential. One is whether diagnostic performance continues to be high when a new, non-overlapping clinical area is added. The second is whether generalists and specialists are willing to adopt the tool to improve referrals and diagnosis. Aim 1 is to add rheumatology diseases to the existing diagnostic decision support tool. Pediatric rheumatology content will be added to the SimulConsult database, using SimulConsult's evidence-based, open-database approach. Using narrative resources such as textbooks and articles as inputs, diseases and findings (signs, symptoms and lab tests) will be added for the ~100 pediatric rheumatology disease, as well as ~200 conditions not already in the database that are likely to arise in the differential diagnosis. For a subset of 25 diseases this information will be further refined by experts using disease-based, finding-based and case-based editing, adding data frequently omitted from narrative material about findings in a disease but known to experts. Aim 2 is to assess the diagnostic effectiveness and efficiency, and appropriateness of referrals. The functioning of the decision support software will be measured by testing clinicians on diagnosis and workup of real cases, before and after using the diagnostic decision support. Testers will include generalists (pediatricians, family practitioners, and emergency department pediatricians) and rheumatologists, both senior and junior. Aim 3 is to assess whether modifications to the data structure are needed to deal with issues such as different granularity of information in different areas of medicine, and develop effective approaches to those needs. Current structures in SimulConsult such as modifier findings and bundles of findings will be assessed and modified as necessary to represent findings simultaneously to rheumatologists and neurogeneticists. Success plus input about what else will be needed for adoption will set the stage for a second phase to scale up detailed coverage across the remaining 275 diseases relevant to pediatric rheumatology and to make the required changes for adoption. PUBLIC HEALTH RELEVANCE: Empowering Physicians with Evidence-Based Decision Support for Pediatric Rheumatologic Diagnoses. This project responds to a critical shortage of pediatric rheumatologists by enlisting top rheumatologists to encapsulate the diagnostic information in their field in the most advanced decision support software tool for diagnosis. The project tests workability of integration into a tool used in other areas of medicine and assesses the benefits of such rheumatology assistance for both rheumatologists and general clinicians. By doing so, it tests whether this decision support approach can be used more widely to improve accuracy and cost- effectiveness in medicine.